An aspirin a day keeps the doc away
Your Health
DR GITA MATHAI
No one likes to be ill, and once the inevitable occurs, one does not want to swallow a large number of multicoloured tablets of all shapes and sizes.
Can you not reduce the number of tablets? I am sure if I take all these I will suffer side effects! Can I not alter the disease process with diet alone? Can I switch to a different system of medicine?
Common queries that busy physicians seldom address patiently.
Anyone who does not wish to have a chronic disease (and swallow tablets for the rest of his or her life) has to take care of his or her health from an early age.
Today, lifestyle diseases such as obesity, diabetes, hypertension and heart disease are rampant. Unfortunately, these diseases usually occur in combination. One of the diseases, say hypertension or diabetes, may start alone as a result of obesity and abnormal lipid profiles, which are often due to inactivity and an improper diet. Then there is a cascading effect — obesity leads to an abnormal lipid profile to diabetes or hypertension to heart disease.
So a person ends up taking tablets several times a day to keep the sugar under control, the blood pressure within limits and the lipids in check. Add a B complex and calcium supplement and you are looking at around 5-6 tablets a day.
The pharmaceutical industry has been working overtime to make life easier for such patients. They have come up with fixed drug combinations so that patients can take one tablet instead of two or three. The idea is good but combination medicines often fail to live up to their potential. This is because the dosage ratios are fixed; so too much or too little of one or more of the medications may be taken. Drugs that need to be taken before and after food may also be inappropriately administered. Sometimes combinations are irrational, with two antagonistic drugs being combined. Occasionally, both medications compete for the same site in the intestine for absorption so that eventually neither works! In fact, if you are prescribed combination tablets, ask your doctor if it is possible to take the tablets individually.
The combination tablets are a response to people’s demand for a “magic bullet”, a single medication that at a low dose, with a wide margin of safety, and few or no side effects, will cure all their ailments. Actually centuries ago, ancient cultures like that of the Indians, the American Indians, the Chinese, the Egyptians and the Greeks did have something like a magic bullet. Medicine men or healers brewed infusions or teas with the petals of a flowering plant — the Spiraea ulmaria — which relieved pain caused by injury, toothache, headache, and arthritis. Hippocrates even successfully administered it to ease the pain of childbirth. Eventually, about a hundred years ago, Felix Hoffmann, a chemist working for Bayer, synthesised the active ingredient in Spiraea ulmaria — salicylic acid. And that has evolved into the aspirin we use today.
Aspirin reduces pain, fever and headaches. It can be used to prevent clotting of blood, which helps prevent strokes, heart attacks and miscarriage. Aspirin also retards the onset and progress of Alzheimer’s and dementia. And it has been shown to reduce the incidence of many types of adenocarcinomas, especially that of the colon. That does make it magic but aspirin can’t cure a lifestyle disease. An aspirin a day, however, can keep lifestyle diseases away.
The other thing that can prevent them is maintaining ideal body weight, which is calculated by measuring the body mass index or BMI (weight in kilograms divided by height in meter squared). Values up to 24 are normal, 25-29 is defined as overweight, 30-34 obese and anything above that as extremely obese.
A person’s weight starts the upward climb because of an imbalance between food intake and physical activity. Environmental factors are important as both these factors are strongly influenced by habits learnt in childhood. Families that enjoy excessive amounts of calorie-dense food with refined sugars and oil and inadequate amounts (less than the recommended 400mg) of pulses, vegetables and fruits tend to have overweight children who grow up to be obese. To avoid addiction to high-calorie foods, stock fruits and vegetables as snacks. Have plain water instead of carbonated drinks and pack home-cooked food for school lunches instead of the packaged variety.
In addition, exercise is essential. It conditions the body, improves immunity, and delays, and sometimes prevents, the onset of lifestyle diseases and some cancers. Adults require an hour of aerobic activity (walking, jogging, running or swimming) followed by 20 minutes of flexion, core strengthening or yoga a day.
In short, a balanced diet, exercise and 75mg of aspirin a day should keep you healthy!
Before popping an aspirin, however, remember that it is contraindicated in children, people with bleeding disorders and those with gastric or duodenal ulcer. Aspirin is available without a prescription but please check with your doctor before you start taking it.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Tuesday, October 25, 2011
Monday, October 10, 2011
schizophrenia
Let’s talk about schizophrenia
Your Health
DR GITA MATHAI
People sometimes change inexplicably in their late teens – they behave bizarrely, argue unnecessarily with everyone, imagine events, become suspicious or withdraw into a shell. This is actually a disease called schizophrenia and these forms are classic, delusional, paranoid and catanonic. The word itself means "split mind " in Greek as it was confused with a multiple personality disorder by earlier physicians. Today, these two illnesses are classified separately.
Schizophrenia is a serious mental illness that is likely to affect one in 100 men and women (0.5-0.7 per cent respectively). It strikes people usually in their late teens and twenties. It is rare for schizophrenia to set in after the age of 40 and children are rarely diagnosed with it. They can, however, go on to develop it as adults if they have some other mental illness such as autism.
The onset of schizophrenia is so gradual that it mostly goes unrecognised and untreated, especially in developing countries with inadequate healthcare. In addition, people baulk at the idea of admitting they or a loved one is suffering from schizophrenia though no one has a problem saying they have an incurable chronic illness like diabetes or hypertension.
Schizophrenic patients may be delusional or hallucinate — that is see and hear things that are not real. Their speech may be disconnected, dressing and behaviour may be socially inappropriate and they may cry and laugh for no reason at all. Sometimes the person may be “catatonic” or unresponsive to any external stimulus.
Unreasonable behaviour and a quarrelsome nature may affect relations with friends, family and colleagues. The person may be unable to keep a job. Insomnia and morning drowsiness affect efficiency. The appetite may be poor.
The diagnosis of schizophrenia is difficult as the symptoms evolve gradually over a period of months or years. It is often difficult to pinpoint the exact date at which the changes were noticeable. The symptoms should be present for a month for schizophrenia to be suspected and remain for six months for the diagnosis to be established. The patient or a caretaker can report the symptoms. They should be substantiated by evaluation by a qualified medical professional.
PET scans also do not strictly conform to normal parameters. The brains in schizophrenics have smaller temporal and frontal lobes. The levels and ratios of certain brain chemicals like serotonin, dopamine and glutamine are altered.
The exact reason for these behaviour altering brain changes is not known. However, seven per cent of persons with schizophrenia have a family member who suffers from a similar disease. Many have been born to mothers who suffered several viral illnesses during pregnancy. Environmental factors also play a role — the incidence of the disease increases in persons who are financially insecure or from dysfunctional families with a history of childhood abuse.
Schizophrenics tend to gain weight because their lifestyle is sedentary. Patients also have a predilection for addiction — to tobacco products, alcohol and drugs like cannabis. They are often unwilling to check the addictions to control lifestyle diseases like diabetes or hypertension. Also, they do not adhere to diet modifications or medications needed to keep their disease in check; so this shortens lifespan. They eventually die 10-15 years earlier than their peers. They are also 15 per cent more likely to commit suicide.
Gone are the days when schizophrenics were locked up, immersed in cold baths or given electrical shock therapy. Today there are a plethora of drugs that can be used singly or in combination to control the symptoms of schizophrenia and help the person function fairly normally. These drugs act by correcting the enzyme and chemical imbalances in the brain. Response to medication may be slow and this may be frustrating for the patient as well as caregivers but medication can be increased only gradually to optimal levels. Drugs, combinations and dosages have to be individualised and vary from person to person.
The side effects of medication are weight gain, menstrual irregularities and drowsiness. Some people become very stiff and have abnormal smacking movements or grimaces but doctors are able to tackle this with other medications.
Rehabilitation is important. Once the symptoms are controlled, patients can function in society and even hold down jobs. They need to be trained to handle money and in personal care and hygiene. Medication needs to be continued even when the symptoms have disappeared. The involvement of the whole family helps as the person is then more likely to follow medical treatment and less likely to relapse.
People often ask for a “miracle drug” — a single tablet to treat all diseases. The only universal ingredient to improve health in all diseases (even mental problems) is physical exercise. So go take a walk.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
DR GITA MATHAI
People sometimes change inexplicably in their late teens – they behave bizarrely, argue unnecessarily with everyone, imagine events, become suspicious or withdraw into a shell. This is actually a disease called schizophrenia and these forms are classic, delusional, paranoid and catanonic. The word itself means "split mind " in Greek as it was confused with a multiple personality disorder by earlier physicians. Today, these two illnesses are classified separately.
Schizophrenia is a serious mental illness that is likely to affect one in 100 men and women (0.5-0.7 per cent respectively). It strikes people usually in their late teens and twenties. It is rare for schizophrenia to set in after the age of 40 and children are rarely diagnosed with it. They can, however, go on to develop it as adults if they have some other mental illness such as autism.
The onset of schizophrenia is so gradual that it mostly goes unrecognised and untreated, especially in developing countries with inadequate healthcare. In addition, people baulk at the idea of admitting they or a loved one is suffering from schizophrenia though no one has a problem saying they have an incurable chronic illness like diabetes or hypertension.
Schizophrenic patients may be delusional or hallucinate — that is see and hear things that are not real. Their speech may be disconnected, dressing and behaviour may be socially inappropriate and they may cry and laugh for no reason at all. Sometimes the person may be “catatonic” or unresponsive to any external stimulus.
Unreasonable behaviour and a quarrelsome nature may affect relations with friends, family and colleagues. The person may be unable to keep a job. Insomnia and morning drowsiness affect efficiency. The appetite may be poor.
The diagnosis of schizophrenia is difficult as the symptoms evolve gradually over a period of months or years. It is often difficult to pinpoint the exact date at which the changes were noticeable. The symptoms should be present for a month for schizophrenia to be suspected and remain for six months for the diagnosis to be established. The patient or a caretaker can report the symptoms. They should be substantiated by evaluation by a qualified medical professional.
PET scans also do not strictly conform to normal parameters. The brains in schizophrenics have smaller temporal and frontal lobes. The levels and ratios of certain brain chemicals like serotonin, dopamine and glutamine are altered.
The exact reason for these behaviour altering brain changes is not known. However, seven per cent of persons with schizophrenia have a family member who suffers from a similar disease. Many have been born to mothers who suffered several viral illnesses during pregnancy. Environmental factors also play a role — the incidence of the disease increases in persons who are financially insecure or from dysfunctional families with a history of childhood abuse.
Schizophrenics tend to gain weight because their lifestyle is sedentary. Patients also have a predilection for addiction — to tobacco products, alcohol and drugs like cannabis. They are often unwilling to check the addictions to control lifestyle diseases like diabetes or hypertension. Also, they do not adhere to diet modifications or medications needed to keep their disease in check; so this shortens lifespan. They eventually die 10-15 years earlier than their peers. They are also 15 per cent more likely to commit suicide.
Gone are the days when schizophrenics were locked up, immersed in cold baths or given electrical shock therapy. Today there are a plethora of drugs that can be used singly or in combination to control the symptoms of schizophrenia and help the person function fairly normally. These drugs act by correcting the enzyme and chemical imbalances in the brain. Response to medication may be slow and this may be frustrating for the patient as well as caregivers but medication can be increased only gradually to optimal levels. Drugs, combinations and dosages have to be individualised and vary from person to person.
The side effects of medication are weight gain, menstrual irregularities and drowsiness. Some people become very stiff and have abnormal smacking movements or grimaces but doctors are able to tackle this with other medications.
Rehabilitation is important. Once the symptoms are controlled, patients can function in society and even hold down jobs. They need to be trained to handle money and in personal care and hygiene. Medication needs to be continued even when the symptoms have disappeared. The involvement of the whole family helps as the person is then more likely to follow medical treatment and less likely to relapse.
People often ask for a “miracle drug” — a single tablet to treat all diseases. The only universal ingredient to improve health in all diseases (even mental problems) is physical exercise. So go take a walk.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Thursday, October 6, 2011
heralding diabetes
A herald of diabetes
Your Health
DR GITA MATHAI
The young woman who walked in for a consultation had a scarf wound around her neck. “I came to show you this,” she said, taking it off. There was a dark patch on the back of her neck with ridges and bumps, the skin raised and velvety. “I have already tried fairness creams,” she said. “They only make it worse.”
The diagnosis was easy. She had a peculiar skin lesion known as acanthosis nigricans.
The cosmetically disfiguring and aesthetically displeasing lesions usually occur on the neck (where they are clearly visible), armpit, groin, knees or elbows, in short areas with skin folds. Very rarely, it can be found on the fingers or around the lips or in the nipple area. It can occur at any age and in both men and women. It is seen in children and even in babies. The lesions appear gradually and do not itch or pain. This means that they remain unnoticed until they have spread over a large area. Initially it looks like dirt so people try to scrub it off, damaging the skin in the process. Others try to camouflage it unsuccessfully with talcum powder and make up.
Nearly 20 per cent of the population has acanthosis nigricans and the numbers are rising rapidly because obesity is the commonest risk factor. More and more people are becoming overweight in India and the world.
An inactive lifestyle causes weight gain and these two factors together cause relative insulin resistance, which results in elevated glucose levels, an abnormal lipid profile and high blood pressure. These changes are grouped together as the “metabolic syndrome X”. Acanthosis nigricans is one of the early markers of this syndrome. The American diabetic association classified it as a risk factor for the development of diabetes in 2000. In children and adolescents, symptoms of syndrome X or frank diabetes begin to appear within two years of the appearance of acanthosis nigricans.
The disease can also be hereditary and in typical inherited acanthosis nigricans, skin lesions are confined to one half of the body. They spread and increase till a certain age and then remain stationery or regress. In other families the lesions, though present in almost all family members, are not really hereditary. The biggest difference is that they are present on both sides of the body. The family usually has an inactive lifestyle, members are obese and go on to develop diabetes.
Medications can also cause these skin changes as a side effect. The most common offenders are hormones — like oral contraceptive pills (OCP), hormone replacement therapy (HRT), insulin, pituitary extract, growth hormone or systemic corticosteroids. Unfortunately, pituitary extract or steroids may be added to unregulated “natural herbal supplements” or “tonics” so the person may not even know that he or she is ingesting such substances. Sulpha drugs (antibiotic)and nicotinic acid (for high cholesterol) can also cause these.
Certain types of acanthosis nigricans are peculiar to women. It is associated with the polycystic ovary syndrome and appears at adolescence. Such girls are obese and have irregular periods and facial hair.
If you develop acanthosis nigricans, it is worthwhile consulting a physician. Although you may be obese, and that is the commonest cause of these skin changes, some investigations and tests need to be done. This is because the skin changes can (though this is rare) be associated with cancer, particularly in the abdomen. It can appear before any other obvious sign of a tumour. It can also be a part of the spectrum of autoimmune diseases like systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis.
There really is no specific treatment for the skin changes in acanthosis nigricans. The disease itself is harmless. The main danger lies in the complications associated with obesity and insulin resistance. Tackling the underlying problem makes the skin lesions fade. Here is what you can do to tackle it:
• If it is due to medication or health supplements, stop taking them.
• Reduce your weight with diet and exercise. Try to reach your ideal body weight (height in meter squared multiplied by 23).
• Eat more protein, fresh fruits and vegetables. Starches and sugars provide empty calories and aggravate insulin resistance.
• Sweat trapped in the folds can make the lesions malodorous. Bathe twice a day with a medicated soap like Neko if that is the case.
• Evening primrose oil or fish oil supplements may help.
• Some prescription creams or lotions help lighten the affected areas. These contain modified vitamin A products and are often prescribed for acne.
• Fairness creams do not help.
• Surgical dermal abrasion can be done.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
DR GITA MATHAI
The young woman who walked in for a consultation had a scarf wound around her neck. “I came to show you this,” she said, taking it off. There was a dark patch on the back of her neck with ridges and bumps, the skin raised and velvety. “I have already tried fairness creams,” she said. “They only make it worse.”
The diagnosis was easy. She had a peculiar skin lesion known as acanthosis nigricans.
The cosmetically disfiguring and aesthetically displeasing lesions usually occur on the neck (where they are clearly visible), armpit, groin, knees or elbows, in short areas with skin folds. Very rarely, it can be found on the fingers or around the lips or in the nipple area. It can occur at any age and in both men and women. It is seen in children and even in babies. The lesions appear gradually and do not itch or pain. This means that they remain unnoticed until they have spread over a large area. Initially it looks like dirt so people try to scrub it off, damaging the skin in the process. Others try to camouflage it unsuccessfully with talcum powder and make up.
Nearly 20 per cent of the population has acanthosis nigricans and the numbers are rising rapidly because obesity is the commonest risk factor. More and more people are becoming overweight in India and the world.
An inactive lifestyle causes weight gain and these two factors together cause relative insulin resistance, which results in elevated glucose levels, an abnormal lipid profile and high blood pressure. These changes are grouped together as the “metabolic syndrome X”. Acanthosis nigricans is one of the early markers of this syndrome. The American diabetic association classified it as a risk factor for the development of diabetes in 2000. In children and adolescents, symptoms of syndrome X or frank diabetes begin to appear within two years of the appearance of acanthosis nigricans.
The disease can also be hereditary and in typical inherited acanthosis nigricans, skin lesions are confined to one half of the body. They spread and increase till a certain age and then remain stationery or regress. In other families the lesions, though present in almost all family members, are not really hereditary. The biggest difference is that they are present on both sides of the body. The family usually has an inactive lifestyle, members are obese and go on to develop diabetes.
Medications can also cause these skin changes as a side effect. The most common offenders are hormones — like oral contraceptive pills (OCP), hormone replacement therapy (HRT), insulin, pituitary extract, growth hormone or systemic corticosteroids. Unfortunately, pituitary extract or steroids may be added to unregulated “natural herbal supplements” or “tonics” so the person may not even know that he or she is ingesting such substances. Sulpha drugs (antibiotic)and nicotinic acid (for high cholesterol) can also cause these.
Certain types of acanthosis nigricans are peculiar to women. It is associated with the polycystic ovary syndrome and appears at adolescence. Such girls are obese and have irregular periods and facial hair.
If you develop acanthosis nigricans, it is worthwhile consulting a physician. Although you may be obese, and that is the commonest cause of these skin changes, some investigations and tests need to be done. This is because the skin changes can (though this is rare) be associated with cancer, particularly in the abdomen. It can appear before any other obvious sign of a tumour. It can also be a part of the spectrum of autoimmune diseases like systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis.
There really is no specific treatment for the skin changes in acanthosis nigricans. The disease itself is harmless. The main danger lies in the complications associated with obesity and insulin resistance. Tackling the underlying problem makes the skin lesions fade. Here is what you can do to tackle it:
• If it is due to medication or health supplements, stop taking them.
• Reduce your weight with diet and exercise. Try to reach your ideal body weight (height in meter squared multiplied by 23).
• Eat more protein, fresh fruits and vegetables. Starches and sugars provide empty calories and aggravate insulin resistance.
• Sweat trapped in the folds can make the lesions malodorous. Bathe twice a day with a medicated soap like Neko if that is the case.
• Evening primrose oil or fish oil supplements may help.
• Some prescription creams or lotions help lighten the affected areas. These contain modified vitamin A products and are often prescribed for acne.
• Fairness creams do not help.
• Surgical dermal abrasion can be done.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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